Week after week, patient’s present to our office with their Aetna ID card. We call to check for acupuncture benefits and are told, time and time again, that they HAVE coverage. The patient has already done their own research and knows that they are supposed to have coverage. Yet, with the first billing, the denial comes. Now, as it turns out, when verifying insurance, the burden is on us to ask each and every pointed question since the person on the other end providing the benefit information is typically clueless and in a foreign country where English is, at best, a second language.
We must now specifically ask if acupuncture is ONLY covered in lieu of anesthesia or to treat nausea and vomiting related to chemotherapy…then through previous trial and error we know that if they do actually have acupuncture coverage then it is only for the handful of conditions specifically listed in their clinical service bulletin. This lists the diagnosis’ deemed treatable with acupuncture; migraines, low back pain, and a variety of osteoarthritis conditions. No regular headaches, no neck pain, no post-operative pain….nothing else. Heaven help you if you bill for something not on the list. The denials will flow in and the enraged patient will be calling, very indignantly stating that they have acupuncture benefits. Somehow, it’s always our fault no matter how much pre-emptive work we try to do. At the end of the day, I really have to wonder, does Aetna REALLY cover acupuncture? Not for about 95% of cases.